When Is It Right to Step In?

It’s one of the most difficult questions to answer as an adult child: When does dementia become so serious that your elder is simply no longer able to cope? When is it time to find a geriatric specialist? When do you step in and take action?

I knew for several years that my mother was failing. She had once been a successful trial attorney, one who prided herself on her independence, mental as well as financial. But after my father died, the little signs of decline started to accumulate: Mom started to get into little fender-benders; these car accidents were always someone else’s fault, Mom said. The power company and the phone company called every couple months about unpaid bills. “They are so rigid!” Mom complained. Neighbors called me to report that Mom’s lovely Edwardian house was going to rack and ruin: Mice in the kitchen! Weeds in the front yard! Every time we hired somebody to help, my mother judged them to be inadequate and fired them.

Think Realistically, Don’t Always Justify Things

For quite a while, my family explained away incident after incident. We lurched from crisis to crisis. Then, things got serious: Mom started to do what I now know as “sundowning,” she had anxiety attacks every evening as dusk approached. Though she lived in San Francisco, and I then lived in New York City, she’d call every day, hysterical, insisting that I help her, that I come over that instant. When I explained that it was at least a 9-hour trip, she was unmoved. “Help me! Help me!” she’d cry.

Even more serious incidents followed: Mom began to fall. Eventually, she hurt herself so badly tumbling down the front steps that she was hospitalized. In the hospital, she began to have paranoid delusions. She called me to insist that UC-San Francisco was being taken over by the Nazis. I had to come home right away before the doctors sent her to the gas chamber, she insisted. She started throwing meal trays and glasses at the nurses. I flew home to figure out what to do.

I contacted Elder Consult and set up a home visit. Dr. Landsverk came over and did a full evaluation. She took a full history and asked my mother what her goals were. At that time, Mom was still lucid enough to answer. As a family, we came up with a plan that preserved as much of my mother’s abilities as possible, while also addressing the depression, anxiety and paranoid delusions that so often accompany dementia. Dr. Landsverk also put us in touch with a fiduciary, a person who could help Mom with her finances. She helped us find caregivers that my mother liked.

Don’t Be Afraid to Reach out for Help

Several years have passed. My mother’s dementia and other medical problems have progressed and she is now bedridden. I and my family have moved back to San Francisco to help care for my mother. The caregivers that Dr. Landsverk helped us find have become like extended family members.

As my mother’s condition has worsened, her psychological challenges have waxed and waned. Each time, Dr. Landsverk has found a combination of medications that have kept my mother as clear-headed as she can be while also softening her paranoia and anxiety. Without these medications, my mother becomes abusive and violent. She becomes paranoid, she refuses to be bathed or to have her diaper changed. Without the expertise of the Elder Consult team, my family would be unable to care for my mother at home.